NPI | 1609854934 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: TX L5537) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX L5537) |
208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX L5537) | |
Enumeration Date | 2006-01-06 |
Last Update Date | 2013-12-27 |